Exploring occupational therapy intervention for young children with autism spectrum disorder in South Africa.

Abstract

Occupational Therapy is amongst the top three interventions sought for young children with ASD in South Africa. Due to scarce local research on OT for ASD, this study explored the nature as well as perceptions of OTs on intervention for ASD. Using a qualitative exploratory study design, semi-structured interviews were conducted with twenty OTs in public and private health, as well as special needs education. Thematic analysis was used to analyse transcribed data. OTs descriptions and perceptions of assessment, direct and indirect intervention as well as challenges facing families and undergraduate and qualified OTs in South Africa were explored. Assessment for ASD utilised play based skilled observations with limited use of standardised tests. Developmental approaches were preferred to behavioural ones, with the majority of OTs referencing the Sensory Integration (SI) framework for assessment and therapy, even if they were not SI certified practitioners. The value of SI in reframing a child’s behaviour for parents was significant. The South African Model of Creative Ability was a unique local application to practice for ASD. Intervention in education was most ASD specific, including AAC and visual approaches due to a comprehensive programme and greater levels of team collaboration. A family focussed practice was most evident in private and public health. Direct individual therapy was predominant, with all sectors struggling to provide the intensity of therapy recommended for ASD, due to unique contextual challenges. Undergraduate training is insufficient preparation for working with ASD and a need for local OT specialists was identified. Implications for research and practice are discussed.